Adult BOOSTER

Pediatric PRIMARY SERIES

INFANRIX or DAPTACEL (DTaP): 0.5 mL IM (x 5 doses) 2, 4, and 6 months of age, followed by 2 booster doses, administered at 15 to 18 months of age and at 4 to 6 years of age.

DT (< 7 years old): starting at 6 weeks administer three doses of 0.5 mL IM 4 to 8 weeks apart, followed by 2 booster doses, administered at 15 to 18 months of age and at 4 to 6 years of age. (Used when pertussis vaccine contraindicated.)

CLINICAL EFFICACY

18 tetanus cases reported in 2009. Almost all cases were reported in the individuals who were never vaccinated or completed series but did not receive booster.

OTHER INFORMATION

Need: about 25% of U.S. adults > 70 yrs to have protective tetanus ab titers.

Most cases in U.S. occur in intravenous drug users, individuals with diabetes; presumed underimmunized, waning or no immunity.

DT: pediatric preparation, contraindicated in persons >7 yrs.

ADACEL contains the same tetanus toxoid, diphtheria toxoid, and five pertussis antigens as those in DAPTACEL (pediatric DTaP), but ADACEL is formulated with reduced quantities of diphtheria toxoid and detoxified pertussis toxin.

Comment: In 2012 ACIP updated its recommendations to include recommendation to vaccinate all adults ≥65 y/o with Tdap vaccine. In 2011, FDA approved expanding the age indication for Boostrix to aged 65 years and older. This recommendation supersedes previous recommendation about Tdap vaccination in adults 65 y/o.

Comment: Updated recommendations for Tdap to be used in place of Td booster for at least one dose despite lack of FDA approval recommended that un-immunized adults age 65 and older be immunized with Tdap if in contact with an infant. Since 2005, the ACIP has recommended Tdap for all adolescents aged 11 – 18 years with preference of administration ages 11 or 12and for adults 19 through 64 years who is and who have not received a dose.